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SUMMARY
Sexual and drug use behaviors associated with HIV among female IDUs in Estonia
Only few of the studies examining the behaviour of injecting drug users (IDUs) carried out so far have been focused on sexual risk behaviour among female IDUs and risk factors related to HIV infection among female IDUs. In Estonia the HIV-positive mainly include men of reproductive age, however, the proportion of HIV-positive women from all people diagnosed with HIV has been increasing in years as incidence of HIV among men has been decreasing. While in 2000, 20% all HIV-positives were female, in 2004, the relevant percentage was 32%. The studies carried out in the world have shown that IDUs of different gender practise different risk behaviours. The objective of this work was to examine injecting and sexual risk behaviour among female IDUs and the relationship between risk behaviour and HIV prevalence.
The present analysis is a part of anonymous cross-sectional studies “HIV prevalence and risk behaviour among injecting drug users in Tallinn and Kohtla-Järve” carried out in Estonia in 2005, 2007 and 2009. In the studies respondent driven sampling (RDS) was used to involve subjects. RDS is a chain-referral method that is well suited for studying “hidden”
populations, the number and limits of which are unclear and, thus, there is also no sample framework. In 2005, 450 injecting drug users participated in the study, 74 of them were female, in 2007, the number of participants was 689, including 105 women and in 2009, the number of participants was 329, including 87 women. The analysis of this study involved 174 female IDUs (95 HIV-positives and 79 HIV-negatives) who participated in the studies of 2005, 2007 and 2009. 65.8% of the women were under 25 years of age. 80.5% of the women were Russian-speaking, half of the participants were single and slightly more than half of the participants had children. 55.7% of all participants had less than nine years of education and 26.9% were employed. HIV prevalence among the women who participated in the study was 54.5%. 45.3% of both HIV-positive and HIV-negative women injected every day. In general, awareness of study subjects of the risks of being infected with HIV arising from needle sharing is high among both HIV-positive (95.0%) and HIV-negative (97.3%) subjects.
The adapted analysis showed a significant relationship between an experience in drug overdose related to HIV seropositivity and narcotic substances (AOR=2.82; 95% CI 1.01–
7.84), the drug mainly used (AOR=0.26; 95% CI 0.08–0.8), having a regular HIV-positive
40
partner (AOR=3.53; 95% CI 1.2–1.41) and earlier testing for HIV (AOR=7.47; 95 % CI 1.21–
45.94).
Despite the high awareness of HIV prevalence, female IDUs still practise a high-risk sexual behaviour regardless of their HIV sterostatus.
41
TÄNUAVALDUS
Minu siiras tänu kuulub:
• juhendajale professor Anneli Uuskülale, kelle väärtuslikud nõuanded, soovitused, kommentaarid ja aus kriitika aitasid oluliselt magistritöö teostamisel;
• TÜ tervishoiu instituudi statistikule Heti Pisarevile abi eest uuringuanalüüsi tegemisel;
• kõigile teistele, kes antud töö valmimisele kaasa aitasid;
• minu perekonnale mõistva suhtumise ja moraalse toe eest.
42
43
PUBLIKATSIOON
44
Kängsepp Ave, Pisarev Heti, Talu Ave, Abel-Ollo Katri, Rüütel Kristi, Uusküla Anneli.
Sexual and drug use behaviors associated with HIV among female IDUs in Estonia.
Käsikiri on 29.07.2010 esitatud avaldamiseks ajakirjas International Journal of STD & AIDS.
45 Title:
Sexual and drug use behaviors associated with HIV among female IDUs in Estonia
Authors:
Ave Kängsepp 1, Heti Pisarev 1, Ave Talu 2, Katri Abel-Ollo 2, Kristi Rüütel 3, Anneli Uusküla 1, 4
1 Department of Public Health, University of Tartu, Tartu, Estonia
2 Estonian Drug Monitoring Centre, National Institute for Health Development, Tallinn, Estonia
3 Department of Infectious Diseases and Drug Abuse Prevention, National Institute for Health Development, Tallinn, Estonia
4 Estonian Centre of Behavioural and Health Sciences, Tallinn/Tartu, Estonia
Address correspondence to:
Ave Kängsepp
Department of Public Health, University of Tartu Ravila 19, Tartu 50411
Phone: +372.5303.0971
Email: Ave.Kangsepp@mail.ee
Sources of support:
The study was supported by Civilian Research Development Foundation (grants ESX0-2722-TA-06 and ESBI-7002-TR-08); by EU commission funded project "Expanding Network for Coordinated and Comprehensive Actions on HIV/AIDS Prevention among IDUs and
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Bridging Populations" No 2005305; by The Global Fund to Fight AIDS, Tuberculosis and Malaria project “Scaling up the response to HIV in Estonia“; Norwegian Financial Mechanism / EEA (grant EE0016); grant SF0180060s09 from the Estonian Ministry of Education and Research; and grants R01 035174 and R01 AI083035 from the US National Institutes of Health.
Acknowledgments
We are grateful for Tim Rhodes, Lucy Platt, Natalja Bobrova and colleagues from London School of Hygiene and Tropical Medicine for the their contribution to the 2005 data collection, analysis and publications.
47
Sexual and drug use behaviors associated with HIV among female IDUs in Estonia
ABSTRACT
The aim of this work was to examine injecting and sexual risk behaviour among female injecting drug users (IDUs) and the associations of self reported risk behaviours and HIV prevalence. Data from three cross-sectional studies (2005, 2007, 2009) using respondent-driven sampling was used to recruit IDUs for an interviewer-administered survey and HIV testing is analysed. HIV prevalence among 174 female IDUs recruited was 54.6% (95% CI 47.2–62%). After adjusting for confounding HIV seropositivity was associated with drug overdose (AOR=2.82; 95% CI 1.01–7.84), the drug mainly used (AOR=0.26; 95% CI 0.08–
0.8), having a regular HIV-positive partner (AOR=3.53; 95% CI 1.2–1.41) and earlier testing for HIV (AOR=7.47; 95 % CI 1.21–45.94).
Among female drug users injection and sexual risk are associated with HIV infection. Female IDUs need targeted prevention programs taking into account both – injection risks and sexual risks (incl. reporoductive health issues).
Keywords. HIV, female injecting drug user, Estonia
48 INTRODUCTION
In total 25,656 cases of HIV infection were diagnosed and reported for 2008 by 27 of the 30 EU/EEA countries (61/per million). The three countries in EU with the highest rates of newly diagnosed HIV cases in 2008 were Estonia (406/per million; 545 cases), Latvia (158/per million; 358 cases) and the United Kingdom (119/per million; 7,298 cases)1. Among those cases for which age and sex were reported, 13% were individuals between 15 and 24 years of age and 30% were women. Injecting drug use accounted for 6% of diagnosed HIV cases1.
Estonia is experiencing a concentrated HIV epidemic among IDUs, with one of the highest per capita HIV prevalence in Eastern Europe2. Local studies have documented a high HIV prevalence (~ 50%) among injecting drug users3, 4, 5, 6.
Injecting drug users (IDUs) continue to be at a risk for both parenteral and sexual transmission of human immunodeficiency virus (HIV) infection7, 8. These infections contracted as a result of unsafe injection practices among injecting drug users (IDUs), HIV transmission from infected IDUs to their sexual partners and vertical transmission from infected women to their children9.
Sexual risk behaviour has been shown to be related to partner status, gender, history of injecting, amount of drug use and AIDS knowledge10.
A number of studies suggest that women are more likely to engage in injection and sex risk behaviour than men. Women are more likely to engage in risk behaviours in the context of a